1. Positional variation in detection of Saphenofermal Junction (SF) and Greater Saphenous Vein Reflux Department of Vascular Medicine, Cleveland Clinic Florida, Weston FL
Rajmohan Rammohan MD , Szilvia Udvari MD3, Mehrdad Farid MD1
There was a positive correlation between
reflux and CEAP classification
BACKGROUND
Chronic Venous Disease (CVD) and chronic venous insufficiency is common in general population and the prevalence reported to be 9.4% and 6.6% among adult men and women respectively (1)(2)
Most common finding of chronic venous insufficiency is valvular incompetence (3).
There has been a variety of suggested techniques to elicit venous reflux by vascular authorities and vascular societies.
Variation in suggested proper patient positioning and also in techniques of measurement and interpretation of valsalva maneuver on venous flow, making this test vulnerable to technical and interpretational errors
OBJECTIVE
To identify effectiveness of venous ultrasound examination using Valsalva maneuver in RT-15 position in detection of venous insufficiency
Both categorical presence of reflux were positively
correlated with CEAP classification
METHODS
After IRB approval, medical records of 70 patients were investigated from in our vascular clinic and laboratories in a prospective fashion combining clinical and duplex ultrasound data
All studies performed in hospital based in an ICAVL accredited vascular laboratories
RESULTS
Total of 98 limbs were scanned (from 103 limbs, 5 were excluded because of findings associated with previous DVT).
We were able to successfully elicit venous reflux in 93 limbs in combined RT-15 (Reverse Trendelenburg at 15 degree)and upright positions (95%).
Venous reflux elicited in 78 limb (79%) using RT-15 position only.
Venous reflux elicited and in 5 limbs out of (5%) using upright positions only.
Reflux was not elicited in 15 limbs in either position (15%).4 females)
There was positive correlation between reflux and CEAP classification
CONCLUSIONS
Most reflux was detected in the RT-15 position (94%), while 6% detected in the upright position.
The standing position allowed for absolute increase in detection of reflux by 6%, for a number needed to screen for 17.
PPV of reflux detection at Reverse Trendelenburg at 15 degree is 80% which will increase to 85% with upright position.
There was also a correlation of both categorical number of reflux and intensity of venous reflux with clinical stages of venous disease by CEAP classification.
Grade
Description
C 0
No evidence of venous disease.
C 1
Superficial spider veins(reticular veins) only 
C 2
Simple varicose veins only
C 3
Ankle edema of venous origin
C 4
Skin pigmentation in the gaiter area lipodermatosclerosis
C 5
Healed ulcer
C 6
Active ulcer
REFERENCES
1.Levans CJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in general population: Edinburgh vein study. K Epidemiol. Community Health 1999; 53:149-53
2. Ruckley CV. Chronic venous insufficiency: clinical and duplex correlation the Edinburg vein study of venous disorder in general population. J Vasc Surg 2002; 36:520-5.
3. Golman M. Anatomy and pathophysiology of varicose veins
The authors have nothing to disclose